Still they don't get it

[diogenes]

Thiis review yet again commits the cardinal sin of lumping in together the majority who are indifferent to T4 only therapy, and those who benefit from combination. Another useless waste of paper with as usual, the allegation that T4 only and T4/T3 therapy are no different (though a minority preferred the latter).

Thyroid Vol. 31, No. 11 Reviews and Scholarly Dialog

Benefits and Harms of Levothyroxine/L-Triiodothyronine Versus Levothyroxine Monotherapy for Adult Patients with Hypothyroidism: Systematic Review and Meta-Analysis

Juan Manuel Millan-Alanis, José Gerardo González-González, Andrea Flores-Rodríguez, Naykky Singh Ospina, Spyridoula Maraka, Pablo J. Moreno-Peña, Juan P. Brito, Camilo González-Velázquez, and René Rodríguez-Gutiérrez

Published Online:10 Nov 2021doi.org/10.1089/thy.2021.0270

Abstract

Background: Combined therapy with levothyroxine (LT4)/L-triiodothyronine (LT3) has garnered attention among clinicians and patients as a potential treatment alternative to LT4 monotherapy. The objective of this study was to compare the benefits and harms of LT4/LT3 combined therapy and LT4 monotherapy for patients with hypothyroidism.

Methods: A systematic search in MEDLINE, Scopus, EMBASE, Web of Science, and Cochrane Central Register of Controlled Trials was performed by a librarian from inception date until September 2020. Randomized clinical trials and quasiexperimental studies comparing combined therapy (LT4/LT3) versus monotherapy (LT4) for adult patients with hypothyroidism were considered for inclusion. Independent data extraction was performed by paired reviewers. A meta-analysis comparing standardized mean differences of the effect of each therapy was performed on clinical outcomes and patient preferences. Proportions of adverse events and reactions were assessed narratively.

Results: A total of 1398 references were retrieved, from which 18 fulfilled the inclusion criteria. Results supported by evidence at low-to-moderate certainty evidence did not display a difference in treatment effect between therapies on clinical status, quality of life, psychological distress, depressive symptoms, and fatigue; all measured with standardized questionnaires. Furthermore, meta-analysis of patient preferences revealed higher proportions of choice for combined therapy (43%) when compared with monotherapy (23%) or having no preference (30%). When evaluating treatment adverse events or adverse reactions, similar proportions were observed between treatment groups; meta-analysis was not possible.

Conclusions: The available evidence at low-to-moderate certainty demonstrates that there is no difference in clinical outcomes between LT4/LT3 combined therapy and LT4 monotherapy for treating hypothyroidism in adults, except for a higher proportion of patient preferring combined therapy. Adverse events and reactions appear to be similar across both groups, however, this observation is only narrative. These results could inform shared decision-making conversations between patients with hypothyroidism and their clinicians.

PROSPERO Registration ID: CRD42020202658.

[loueldhen]

Rather than 'These results could inform shared decision making with patients ' how about 'These results show the informed patient that I don't understand anything'.

How many years do the folk unlucky enough not to have found the answer have to wait? As I always say - I'd have been dead if I had had to wait for the research to be done. We know what the treatments are, just try them in advancing order, it could take years to find the right answer for the patient but that's short compared to a lifetime of living hell.

So few good guys please keep trying for us. Thank you.

[helvella Administrator]

Fully agree the usual failure to understand.

Anyway, isn't preferring a combination treatment a valid reason for providing it?

I'm rather glad that they weren't in charge of the recent change in petrol from E5 to E10. They'd have claimed that there is no reason for any cars to fill up with E5 because most do fine on E10. Whereas, engineers and fuel industry people are well aware that some cars simply can't run safely on E10.

[tattybogle]

Give me strength .

Q.

What's a bigger waste of time/money than doing 18 poorly conceived studies on combination therapy ?

A.

paying a librarian to sort through 1398 references to find them again , then paying some reviewers to copy the results out without doing any critical thinking.

Surely we already have enough systemic reviews /meta analysis' of these combination therapy studies ...wonder who encouraged this lot to do another one ?

And i still fail to see how 'getting a recorded statistic that DOUBLE the amount of people preferred combo treatment over levo alone' .... isn't 'A THING'

Presumably the whole point of filtering out the 18 studies that passed their criteria for inclusion was to weed out any that could have been influenced by placebo effect.

So if it's 'a thing' that double the amount preferred it , why does it really matter if that wasn't one of the 'things' the studies were looking for ..... and anyway .. they must have been 'looking ' .. else they wouldn't have the information on preferences... what's the point in asking if you're not going to use the information ?

ranty ranty rant.... But still , thanks for the update diogenes, even if it is balderdash.

*Edit

I've just done a personal 'systemic review' of "The Effect on Stress Levels in Levothyroxine Treated Patients of Repeatedly Reading New Meta Analysis' of Rubbish Research" ...

..... Results .... makes my heart rate go up and i start wanting a fag even though i'm not allowed one till after dinner. ....

Conclusion .... Dunno .... maybe i'll pay a librarian to tell me.

[Musicmonkey]

Presumably diogenes you can write a challenge to these misguided 'experts'? For goodness' sake it shouldn't be that difficult to take the right target group for these studies. Meaningless assumptions otherwise, but harmful ones.

[TSH110 in reply to Musicmonkey]

My thoughts exactly they should be called out for the incompetent researchers they are. No doubt they are too stupid to listen or understand the error of their ways, or why would they proffer such trollop dressed up as science 🙄?

[diogenes Remembering in reply to Musicmonkey]

We already have - this paper is downloadable.

Individualised requirements for optimum treatment of hypothyroidism: Complex needs, limited options

August 2019

Drugs in Context 8:212; 597

DOI: 10.7573/dic.212597

Project: Assessment of T4/T3 control of TSH and percentage of total corporeal T3 contributed directly by the thyroid. Syndrome TComplexity in Medicine: Practical Problems, Their Definitions, Models, and Solutions

Rudolf Hoermann, John Edward M Midgley, Rolf Larisch, Johannes W. Dietrich

[Musicmonkey in reply to diogenes]

Excellent! Thank you for everything you do in support of good thyroid science.

[dolphin5]

At least they’re showing that no harm came from the combination therapy and that a higher proportion of people preferred it!

Surely they should now be asking why people preferred it. “What symptoms did it cure” etc???

[LindaC]

There are few words left... having sat before several of them, I despair for humanity that they are permitted to practice and worse still many being publicly funded in some shape or form.

[vocalEK]

Where is a study that looks at Free T3 levels and provides T3 treatment only for those low in it, with an aim to bring FT3 up into the top third or quadrant of the range?